ACE-Informed Responses in Central Texas: Findings from a Needs Assessment.

The objectives of this study were to examine: a) adverse childhood experience (ACE) knowledge among healthcare professionals in Central Texas; b) prevalence of screening and patient disclosure of ACEs; c) implementation of ACE-informed response strategies; and d) the relationship between ACE knowledge and familiarity, and implementation of ACE-informed response strategies. A needs assessment was conducted using an online survey that included closed- and open-ended questions. Purposive and snowball sampling were utilized to recruit healthcare providers, with a focus on pediatric and women's healthcare providers. Eighty-five healthcare providers completed the survey. Most respondents were unfamiliar with the ACE study, but 59.6% had attended trainings on the impact of trauma on child health. Respondents screened most frequently for mental illness and drug/alcohol abuse in their practice. The most frequently reported ACE-informed response strategies included identifying strengths and utilizing on-site resources, while broader strategies such as creating an ACE-informed culture within their practice were implemented by less than 10% of respondents. ACE knowledge was correlated with two of the ACE-informed response strategies. Although many healthcare providers still lack familiarity with ACEs, awareness of trauma and its impact on child health may be more common. Given the positive correlation between ACE familiarity and ACE-informed response strategies, it appears more education and resources are needed to engage healthcare providers in responding to ACEs. Specific strategies, such as community-wide trainings, opportunities for provider collaboration and communication, and critical analysis of policies, may cultivate a more ACE-informed and ACE-responsive culture.

Climate of Fear: Provider Perceptions of Latinx Immigrant Service Utilization.

Latinx immigrants endure stressors throughout the immigration process that detrimentally impact their health and wellbeing. Yet, they also face substantial barriers to accessing and utilizing services. These barriers might be heightened under the Trump administration, which has implemented policies facilitating increased immigration enforcement and punitive immigration practices. This study utilizes data collected from providers who serve Latinx immigrants in the border state of Texas to better understand current immigrant service utilization behaviors. Individual interviews and focus groups were conducted shortly after the last presidential election to inquire about recruitment, retention, program completion, and resources to address key client risk factors. Applying grounded theory analysis strategies, interviews, and focus group recordings were coded for key themes. Data demonstrated central concerns held by providers serving immigrants, and especially those who are undocumented or in mixed-status families. Concerns were related to the following three themes: (1) undocumented immigrant stressors, (2) limited resources for undocumented immigrants, and (3) service utilization barriers. Lack of services for undocumented immigrants and fear related to service utilization were prominent subthemes. These findings extend our knowledge of stressors and barriers of access and utilization for immigrants during this time period of increased immigration enforcement which have valuable implications for practice and future research. Providers can take concrete actions to educate immigrants, regardless of documentation status, on how their clients' identities will be protected. In addition, intentional trust-building strategies are essential to help overcome fear of utilizing services. Future research should ascertain perspectives of immigrant families, as this study drew perspectives only from providers.